Optimal Reimbursement and Malpractice Sharing Rules in Health Care Markets

When health care sponsors such as HMOs or PPOs can use "utilization reviews" in order to indicate to the provider what type of treatment to administer to the patient based upon a diagnosis that is established by the provider, it is possible to implement the "first best" levels of investment in cost control efforts and in aggressiveness of treatment. The implementation of the "first best" requires the utilization of the prospective reimbursement rule accompanied by the removal of all malpractice liabilities from the provider. In contrast, when the type of treatment cannot be enforced by the payer, implementation of the "first best" is not feasible if the payer places a higher weight on the welfare of consumers than that of providers in its objective function. In this case, the reimbursement scheme deviates from the prospective rule, and the provider assumes liability to part of the cost incurred by society as a result of unsuccessful medical outcomes. When the payer can enforce treatment only partially by establishing bounds on the range of acceptable treatments, a minimal acceptable standard will be established and the outcome will be an intermediate case between the above two extremes.     

Supply and Demand for Medical Care: Or,Is the Health Care Market Perverse?

The argument that health market behaviour is idiosyncratic is reviewed and evidence concerning 'Supplier Induced Demand' is presented. The theoretical basis and implications of this pivotal hypothesis are discussed.     

医养结合与老年人健康养老

医养结合是我国社会养老服务体系的核心内容之一,也是实现养老服务高质量发展的重要内容。文章利用CHARLS2015和2018两期数据,以2016年确立国家级医养结合服务试点作为准自然实验,运用双重差分法实证检验了社区居家医养结合服务对于老年人健康养老的影响。研究发现：（1）社区居家医养结合服务提高了老年人的健康自评,优化了老年人医疗服务利用水平,并显著促进了慢性病管理与门诊就诊随访概率,但对老年人身体机能和精神健康层面的改善并不明显。（2）服务效果受到老年人的个体因素（年龄、性别、收入、婚姻状况等）与代际因素（居住区域、子女个数、是否有子女照料、子女受教育程度等）的异质性影响。（3）机制检验方面,体检、日间照料、上门巡诊、娱乐活动服务等显著提高了老年人的健康自评,优化了慢性病管理和老年人的医疗服务利用水平,提升了老年人的精神健康水平。文章研究认为,社区居家医养结合服务应当重新梳理其主体行为逻辑,逐步优化顶层设计,完善关联制度衔接,构建医养结合服务模式、机制与需求多维度衔接的动态调整机制,弄清不同层次人群在医养结合服务中的现实需求,打破制度壁垒,提高资源与政策制度的衔接能力。文章的研究为进...     

市场经济体制中政府角色的基点：干预特定产业

本文概括了政府调控和干预经济发展的四种模式。在此基础上论证了政府干预特定产业发展模式的必要性、现实性和阶段性。     

以健康旅游为抓手推动医养结合创新发展

为了落实习近平总书记有关要大力发展健康事业,做身体健康的民族的指示精神,推动健康中国国家战略的实施,是进入新时代广大人民群众非常关切的社会问题。在大健康时代的趋势背景下,健康旅游可能会成为未来人们出行的常态化选择。中医药这一民族瑰宝与健康和旅游结合起来,以健康为目的,以旅游为路径,推动医养结合事业深度发展,使我们看到了一个健康新业态的形成。以金秀康养旅游目的地建设为契机,将健康旅游作为抓手,结合瑶医瑶药特色推动医养结合的创新发展,值得探索与期待。     

Mixed Market Competition in a Quality Differentiated Duopoly Model An Approach to Banking Sector

This paper attempts to develop a theoretical framework to investigate the competitive implications of quality choices of financial institutions whereby they charge prices to consumers based on their willingness to pay for the service qualities in the mixed market scenario under vertical product differentiation model. Initially, it analyzes benchmark equilibrium solutions of monopoly and duopoly to establish the degree of quality differentiation between two private banks in an uncover market configuration. Further, it estimates the quality differentiation between private and public banks, and examines the interaction between two market structures keeping public bank as both leader and follower, and then measures the social welfare from different prospectives. The explicit operation of two stages Nash equilibrium game forecasted that public banks＇ monopoly seems to be still better than a private banking, and it is socially optimal. The outcome demonstrates a significant importance of vertical quality differentiation for policy implication in banking industry and provides an insight on the reasons of particular co-existence of public and private banking services in the specified location. In this context, it is concluded that the presence of public banks in banking industries is a crucial condition for obtaining the higher range of social welfare.     

Do Consumers Purchase Too Much Health Insurance? The Role of Market Power in Health‐Care Markets

Several authors have suggested that consumers purchase too much health insurance in private markets. We readdress this issue within a model that combines excess health‐care demand due to health insurance with market power due to monopolistic production of health‐care services. We evaluate the market equilibrium in terms of consumer welfare and social welfare. The consumer welfare criterion suggests that in the market equilibrium consumers in fact purchase too much health insurance coverage. The social welfare criterion, in contrast, suggests that because profits of the health‐care industry are properly accounted for, consumers should purchase more insurance coverage than they choose to do in the market equilibrium.     

管办分离是医药业“三改联动”的必由之路

三改联动可以概括为一体两翼,医疗卫生制度改革是主体,医疗保险制度改革和药品流通体制改革是两翼。基于我国国情,管办分离最简洁的方法就是将各级国有医院从卫生行政部门移交各级国资委。同时在社会医疗保险制度改革中实行管办分离,激发医疗保险机构的信息功能和谈判功能以强化医疗供方声誉机制,带动药品流通体制改革。     

The Need for Regulating a Bayesian Regulator

This paper analyzes the Baron and Myersons (B–M) (Econometrica 50: 911–930 [1982]) scheme of monopoly regulation, a standard representative of Bayesian mechanisms. As is well known, the hboxB–M mechanism (and other related mechanisms) have as an explicit starting point the assumption that the regulator has an unchallenged prior belief about the cost function of the regulated monopolist.We analyze here the consequences resulting from the possibility that this prior belief may be subject to influence or manipulable. As we show in detail, under the B–M scheme, consumers and the regulated monopoly are highly sensitive to the regulators prior belief about the (private) cost information of the monopolist. Therefore, if a regulators beliefs are unaccountable to and unverifiable by a higher ity, the regulator has both the incentive and the possibility to change and/or misrepresent his prior belief when facing pressure or payoffs from interest groups representing consumers or the regulated firm. The results here show that the outcomes under a B–M mechanism favoring one or another interest group can vary over a wide spectrum. The results are consistent with capture theory and rent-seeking explanations of monopoly regulation and suggest the need to exercise care in using the insights and results of Bayesian regulatory theory to inform practice.     

Introduction: Reform in the Provision of Health Care

The term “sustainable consumption” is subject to many interpretations, from Agenda 21's hopeful assertion that governments should encourage less materialistic lifestyles based on new definitions of “wealth” and “prosperity”, to the view prevalent in international policy discourse that green and ethical consumerism will be sufficient to transform markets to produce continual and “clean” economic growth. These different perspectives are examined using a conceptual framework derived from Cultural Theory, to illustrate their fundamentally competing beliefs about the nature of the environment and society, and the meanings attached to consumption. Cultural Theory argues that societies should develop pluralistic policies to include all perspectives. Using this framework, the paper examines the UK strategy for sustainable consumption, and identifies a number of failings in current policy. These are that the UK strategy is strongly biased towards individualistic, market-based and neo-liberal policies, so it can only respond to a small part of the problem of unsustainable consumption. Policy recommendations include measures to strengthen the input from competing cultures, to realize the potential for more collective, egalitarian and significantly less materialistic consumption patterns.     

转轨过程中政府卫生投入与体制改革的评价及建议

健康权是最基本的公民权利,是社会起点公平的保障,对健康投入是国家和政府不可推卸的职责。改革以来,我国卫生费用增长较快,然而卫生绩效却不容乐观。中国医疗卫生体系从改革前被国际组织推崇的典范“沦落”为当前的反面案例,[1]结果令人深思。卫生领域的过度、扭曲的市场化和高度分权化是问题的主要根源。因此,建议确立公共卫生和基本医疗支出的政府主导地位,特别要强化中央财政的支出责任,建立不同层级政府间规范的责任分担与资金筹集机制。通过有效的体制构建以及合理的管理制度安排,提高投入绩效,满足广大人民群众基本医疗需求。     

论妇幼保健院财务的精细化管理

随着社会主义市场经济的发展,医疗卫生市场竞争日益激烈,作为非营利卫生机构的妇幼保健院一方面面临着不可回避的市场竞争,另一方面还面临着政府投入相对减少,管理滞后,竞争实力弱化的各种困难,为了走出逆境,妇幼保健院必须对财务工作进行精细化的管理,改善经营状况,为此,要树立科学发展观和成本效益观,从优化医院财务管理体制着手,对医院一切经营活动实行预算管理和成本管理,加强筹资管理,完善药品和医疗服务价格体系,杜绝浪费,提高经济效益和社会效益,实现可持续发展。     

浅谈健康保险中如何控制“过度医疗”

文章重点探讨了“过度医疗”的成因及影响,并在此基础上分析了在健康保险的风险管控中如何有效地防范过度医疗行为,控制医疗费用以及赔付率的恶性上涨。其中重点探讨了如何与医疗机构协作,控制过度医疗问题的发生。提出了在医疗机构内部建立“加强型医疗督导办公室”,实施第二方和第三方的监督机制,在保险公司内部加强管理模式和方法的创新,控制经营风险。     

我国个人卫生费用变动原因研究

卫生总费用是一个国家卫生费用的总和,它是衡量一个国家卫生部门经济状况的重要指标.自1978年改革开放以来,我国卫生费用支出经历了从国家包办到个人支付的转变,特别是最近几年,个人卫生费用的支出速度增长强劲.本文通过实证研究,揭示了这种现象产生的原因.     

Government Interventions, Market Imperfections, and Technical Inefficiency in a Mixed Economy: A Case Study of Indian Agriculture

This paper uses an output-maximizing framework in the presence of expenditure constraint to measure output loss and input misallocation resulting from market distortions and technical inefficiency. A generalized indirect production function accommodating allocative distortions and technical inefficiency is used. Allocative distortions are captured in terms of effective (shadow) prices in which distortion parameters are both farm- and input-specific. The stochastic frontier approach is used to model technical inefficiency. Using farm-level data on 105 jute growers from West Bengal, India, we find that average output losses due to allocative distortions and technical inefficiency are 6.3% and 14%, respectively.